Intended for healthcare professionals


What do you think is a non-disease?

BMJ 2002; 324 doi: (Published 13 April 2002) Cite this as: BMJ 2002;324:912

Pros and cons of medicalisation

  1. Simon Wessely (, professor
  1. Department of Psychological Medicine, Guy's, King's College, and St Thomas's School of Medicine and Institute of Psychiatry, London SE5 8AF
  2. 122 Gow Street, Padstow, New South Wales 2211, Australia
  3. Yeovil BA21 3SB
  4. BC Cancer Agency/Fraser Valley, 13750 96th Avenue, Surrey, British Columbia, Canada V3V 1Z2
  5. University of Sunderland, Sunderland SR2 7EE
  6. London

    EDITOR—The BMJ's decision to extend participatory democracy to the question of disease is important not so much for the results but because it happened at all.1

    To a previous generation the idea of asking consumers to decide on these matters would have been incomprehensible. Doctors decided which conditions were legitimate and which should be consigned to the outer darkness. In the debate about the nature of neurasthenia at the end of the 19th century all protagonists were in the medical profession and their debates were published in journals. The views of a few well educated and well heeled patients may be inferred from diaries and fiction, but their voices were largely unheard and unheeded.

    Now of course medical authority is in retreat everywhere and the final arbiter of “non-disease” is fast becoming the patient.

    All this is well and good, so why the outrage of so many respondents?1 I suspect it comes from a failure to recognise the different concepts of illness and disease.

    Taking chronic fatigue syndrome as an example from the debate,1 few could now question that it is indeed an illness. It has a nosological status and is clearly associated with suffering, ill health, and disability. The patient's voice must be and is paramount. But is it a disease—that is, has a specific pathological process been identified to account for the above? Chronic fatigue syndrome is not yet a disease because no unambiguous evidence has yet been presented that has commanded widespread acceptance by the scientific community, which remains the arbiter.

    Of course, the syndrome may plausibly make the transition from illness to disease like many other illnesses have done. Or it may not. The traffic is not entirely one way in which illness entities inevitably receive the stamp of scientific approval, usually …

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